Cocanour C S, Moore F A, Ware D N, Marvin R G, Duke J H
University of Texas-Houston Medical School, USA.
J Trauma. 2000 Apr;48(4):606-10; discussion 610-2. doi: 10.1097/00005373-200004000-00005.
Operative management of blunt splenic injury is recommended for adults > or = 55 years. Because this is not our practice, we did a retrospective review to compare outcomes of patients > or = 55 years old versus patients < 55 years old.
During a 5-year period ending in July of 1998, 461 patients (3%) admitted to our Level I trauma center had a blunt splenic injury. Eighty-six patients (19%) died within 24 hours of massive injuries, leaving 375 patients for evaluation. Data were obtained from our trauma registry and medical records.
A total of 29 patients (8%) were > or = 55 years old (mean age, 67 +/- 2 years; mean injury severity score [ISS] 25 +/- 2). Of these, 18 patients (62%) underwent nonoperative management (NOM). A total of 346 patients (92%) were < 55 years old (mean age, 28 +/- 0.6; mean ISS, 20 +/- 1). Of these, 198 patients (57%) underwent NOM. The failure rate was not different between the two age groups (17% vs. 14%). However, the ISS and mortality rate were significantly higher in the older age group that failed (ISS, 29.3 +/- 2.6 vs. 19.5 +/- 2.1; mortality: 67% vs. 4%). None of the deaths could be attributed to splenic injury.
Adults > or = 55 years old with blunt splenic injury are successfully treated by NOM. Although older adults had significantly greater injuries, they had similar failure rates of NOM when compared with younger adults. Older adults had significantly higher mortality, but this was not a result of their splenic injury. Therefore, age should not be a criteria for NOM of blunt splenic injury.
对于年龄大于或等于55岁的成年人，建议对钝性脾损伤进行手术治疗。由于我们并不采用这种治疗方式，因此我们进行了一项回顾性研究，以比较年龄大于或等于55岁的患者与年龄小于55岁的患者的治疗结果。
在截至1998年7月的5年期间，我们一级创伤中心收治的461例患者（占3%）有钝性脾损伤。86例患者（占19%）因重伤在24小时内死亡，剩余375例患者可供评估。数据来自我们的创伤登记处和病历。
共有29例患者（占8%）年龄大于或等于55岁（平均年龄67±2岁；平均损伤严重程度评分[ISS]25±2）。其中，18例患者（占62%）接受了非手术治疗（NOM）。共有346例患者（占92%）年龄小于55岁（平均年龄28±0.6岁；平均ISS，20±1）。其中，198例患者（占57%）接受了NOM。两个年龄组的失败率没有差异（分别为17%和14%）。然而，失败的老年组的ISS和死亡率显著更高（ISS分别为29.3±2.6和19.5±2.1；死亡率分别为67%和4%）。所有死亡均不能归因于脾损伤。
年龄大于或等于55岁的钝性脾损伤成年人通过非手术治疗可成功治愈。虽然老年人的损伤明显更严重，但与年轻人相比，他们的非手术治疗失败率相似。老年人的死亡率显著更高，但这并非其脾损伤所致。因此，年龄不应作为钝性脾损伤非手术治疗的标准。
